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Holism versus dialectics

     Dialectics has been usually understood and used in highly diverse ways depending on historical ages. Using dialogue, Socrates boosted meditation in his pupils so they could manage to reach the "illumination" of the truth. Plato, basing on dialogue as an essential element, distinguished three stages in his arguments: thesis, antithesis and synthesis. Aristotle applied dialectics as an aporetic method. So many and so varied have been the philosophers and methods that have employed dialectics to develop their theories that they would widely exceed the limits and nature of the current article. Dialectics could be defined as the "science of movement" (Heraclitus). However, what can be most interesting about dialectics -from the effort to interpret reality in all its extent- is its great complexity, taking into account that dialectics adopts a "multilaterality of relationships" in order to reflect, examine critically and reach synthetic (globalizing) interpretations of reality. Not in vain, one of the starting premises of the dialectical materialism is the assertion that everything is interconnected and that there is a continuous process of change (movement) in this interrelation. According to Kojeve (1984), Hegel was the first one in transforming dialectics into a process that went beyond dialogue, by introducing its dynamic nature in the description of reality. The human being as an individual and the groups that are constituted at social, political or professional levels, are to be described without renouncing its potentiality for change throughout time.
     Hegel's dialectics is not only a research method or philosophical exposition; it is, before anything else, the most suitable way of describing the structure of the human being and the schemes he adopts to adapt and fulfill his aims in life. Saying that the human is a dialectical being involves asserting: firstly, (at an ontological level), that it embodies a totality that implies both identity and negation. Secondly (at a metaphysical level), that human being fulfills his aims in nature (natural world), but also in a historical world (human world). Thirdly (at a phenomenological level), the human being appears as an entity that exists empirically in a specific moment, but it is really an apparent objectivity that fails to withstand the passing of time without changing, since humans are historical and mortal beings that possess, due to their individual freedom, the capacity of fighting and working to generate changes through creative action (instead of remaining alienated from changes in the chronic immobility of the "slave" (Kojeve, 1984). In this sense, the role of woman and nursing in society shares the already reported features and exposes itself to the dialectical dynamics in a general sense, being one of her differential features the historical absence of a critical knowledge that has stressed the slowdown of her evolution as representative of the oppressed sex (typical of the role of the slave). It was only after the recognition that woman nurses obtain in military conflicts and the rise of the feminist movement that the desire for a change was born and started to become structured.

Identity, negation and synthesis

     From the perspective of Hegel's ontology, three main categories can be established: identity, negativism and totality.

a) Woman's identity as a nursemaid and domestic worker. This identity originates from the respect to traditions inherited from the ancient sexual separation of tasks according to which her work comes clearly marked in daily life: pregnancy, giving birth, breastfeeding and upbringing children. During this stage, identity fosters the ideal of the agreement of thought with oneself and promotes the homogeneity of activities and prospects. We are dealing with a given self-existing identity ("being in oneself" as opposed to "being for oneself"), the justification of which is as remote as the origin of man, as it is asserted and repeated over and over again in myths and beliefs of different cultures. It belongs to a stage of thought that is necessary to overcome, since woman, within this frame, is not a human being that can evolution historically; she is not a person in time, as the "being for herself" is just a "being in herself" condemned to social, professional and educative stagnation and installed in a world of prospects obliterated by a series of chronic and ankylosing activities.

b) Genre Identity, specific identities both for woman and man. There is a previous process to this stage: the human being's identity that reveals itself as a "factotum", where factors of every nature are involved or perhaps man appears only as a consequence of physiological evolution. According to Kojeve, desire is the factor that transforms man in what he actually is (anthropogenic desire), and such desire is likewise causing the emergence of self-awareness. Kojeve asserts that an animal has a self-feeling, but man possesses a self-awareness, what is revealed in the linguistic ability and the conceptual development which key word is "ME". The problem implied by taking the step from the feeling of oneself to the awareness of oneself turns eventually into the problem of distinguishing between animal desire and human desire. According to Kojeve, the mechanism of desire both in the animal and in the human being is a negative mechanism. When someone wishes a thing, he assimilates whatever represents the object of desire, for example, eating. It is "negative" in the sense that he transforms food, assimilating it. However, the animal desire is a desire of things that "reifies".
     The possibility of making man springing up from animal involves a desire that might transcend what is purely physiological and, consequently, might not "reify". For Kojeve, the only existing reality -and this is not natural- is Desire, but in this primeval stage of identity, woman will not go completely beyond the boundary of "being in herself", not desiring to alter her situation with respect to the force that keeps her in a quite similar situation to that of the Hegelian slave's, as both are lacking critical awareness and live in a purely natural and non-historical world.

c) Negation or denying force of the limitations of woman as a nursemaid and domestic worker. "All life that is limited only to mere conservation is a decadence", declares Heidegger as the right dynamics in the way towards evolution and opposes stagnation and submissiveness (Heidegger, 2000). But how could such a process of change that would invigorate the passage from domestic to professional activities within a much wider frame gets started? That is, women claiming for equality in every field and becoming aware of a genre-divided society.
     The negation of her slavish condition or the beginning of women's struggle to get a social, educative and professional recognition is the consequence of a desire (Kojeve, 1984), a polarized drive pushed by the need of changing form "being in herself" to "being for herself". This is the first step by which the human being regards the effort and the struggle as inherent to the overcoming of her "status quo" (of submissiveness, dependence or slavery); that is, it is within each person or group's critical awareness where the primitive impulse lies. Through this impulse it will be fulfilled the drive or desire for a transformation of what is given or pre-existing (Kojeve, 1984) that keeps woman enslaved within a genre-limitations frame in the central nucleus of which can be easily visible domestic and also religious nursery.
     For Nietzsche there is a lords' moral and a slaves' moral. The lords' moral is the moral of aristocracy. Lords or aristocrats produce a self-designed system of values, and this axiological "orthopedics" imposes on the other people most naturally. It occurs not only among individuals; the same mechanism seems to operate in the regulation of the relationship between social, working and professional groups. For example -and only as an instance- doctors (a highly institutionalized professional group) organize the way of acting and thinking of woman nurses (a neo-domestic group acting out of their primitive natural environment, home, which lacked institutionalization levels equivalent to doctors'). It seems evident the transversality of this functioning inherent to Hegel's dialectics, reinterpreted by Kojeve as he exercises his capacity of synthesis to incorporate in his hermeneutic process all the elements than can be valid in contributions so nuclear and dissimilar as those of Hegel (dialectics), Marx (successive historical stages until the abolition of the State as a result of critical awareness and social class-fighting) and Heiddeger (the importance of time for the construction of the individual an his awareness: the historical being). However, if what we desire is to get a holistic vision (frankly transversal) of history in general and nursery in particular, it is necessary to go beyond Kojeve and to point out contributions -as outstanding and complex- as Derrida's deconstructionism.
    A dialectical synthesis will not be possible if thought and its specific product -reflection- are in the service of dogma. For a global vision of phenomena, particularly conflicts, it is essential to develop the capacity of deconstruction to take down all the conceptual, linguistic and axiological machinery that shape the structural support of the ideology and the power it represents. This task of questioning everything given -especially the meaning of language and its distortion of reality- is crucial to transcend beyond those things that prevent us from watching reality as it is. Both woman and nurse have suffered themselves the scathing dictatorship of stereotypes that has kept them jointly, like Siamese twins, within a limited range of prospects that typically responded to a certain prevailing ideology (Nietzsche's aristocrats' moral). However, the trite expression "transversality" makes unavoidable here again, since both ideology and stereotypes and lords' values are only significant if they get to be materialized through language. Derrida accuses language of being a forcer of reality, as it gets distorted. No matter how much one can wish it, any interpretation of reality will mutilate it, and the most flagrant the matter will be as the most exact we intend to be in formulating an interpretation intended to seize phenomena within a dogmatic.stereotyping definition. To sum up, we could express colloquially the following statement: for professional nursing to become a fact, domestic nursing must die. or at least, they have to be differentiated clearly enough from each other to the extent that they have to be completely unmistakable, each one within their own boundaries.
     This process of awareness -everything we have mentioned is part of it- also includes the assumption of the typical risks of historical dynamics, dialectics and the processes of change that entail a high degree of conflicts because of the many different interests among individuals and social, ethnic, cultural and professional groups. The domestic role of woman at home and socio-sanitary tasks traditionally carried out by the female community without trespassing the threshold of daily life, has maintained essentially stable for centuries. The awareness of woman regarding her options for changing this "chronic" situation (lasting in time) has meant a preliminary requirement for any kind of hope or desire of significant transformation in her life. According to the dialectical perspective and to Hegelian ontological categories, it is in this moment where the denial of "being in oneself" (deeply entrenched within the limits of ancient tasks: giving birth, breastfeeding, children upbringing, cares, etc) should take place in order to elaborate a new historical world in which woman will be able to "be for herself" (so crossing the limits imposed by the former category through the acceptance of a perspective free of ideological atavisms). Again adopting a transversal approach, we could compare negativity with the death of pre-existing elements, what can be interpreted as a certain capacity of deconstruction (Derrida, 1998), which in turn is at odds with the alienation caused by the ideological indoctrinations.
     Undoubtedly, the great deeds of those women that have carried out their labour as nurses in successive military conflicts (Kalish, 1981; 1995) have contributed to get a specific social recognition that has reached the masses through information media: Florence Nightingale, Edith Cavell (Kalish, 1981, 1995) and especially cinema (Level, 1973; Siles, 1998) have contributed to dissemination. The heroic deeds of some women nurses meant a support so the society questioned if those women were really useful for something more than for what tradition, values and beliefs (inside a patriarchal society) had reserved for them.

d) Synthesis versus totality: evolution of both woman and nurse in a society in transition. Although we cannot find yet historical conditions that let us point out that the dialectical process has culminated, a hypothetical end could be established when a double synthesis result would be reached:
     - Synthesis woman "being in herself" (absence of a critical awareness and historical changes - woman "being for herself" (construction of a critical awareness and a desire for historical changes).
     - Synthesis domestic worker (carer in daily life) - professional (scientific qualification of cares).
     In spite of the changes, in every dialectical process there always remain some relics that, even in the panorama after the dialectical struggle (within which we are still immersed), are like embers that resist to go out definitely: this is the case of the carer's vocation, in whose identity the motherly dimension and everything else having to do with cares keep on being confused, or the case of the stereotype of the religious woman carer / nun carer, not less stale than the first one. Herein lie the power of words and the huge resistance to the change of their meanings (Foucault, 1981) The words "woman" and "nurse" refer to two situations as fictitious as legitimate, because they both have been sanctioned by the patriarchal society and move them both away from the perception of their authentic realities (prospects: potential realities). As a result, "women" and "nurses" keep themselves within the limits marked by the society for the genre to which they belong. More problematic is, however, when women and nurses themselves, as Kojeve establishes, tend to submit their own thought to these institutionalised stereotypes, keeping themselves in the belief that their situation is a natural one (adoption of the rule of submitted slaves in a supposed and timeless society). In order to go out of this immobility, it is necessary to adopt a new critical awareness (a reflection or questioning of the situation of the slave) that was started at the end of the 19^th century after the alliance between an incipient feminism and the women workers that needed to dignify the few working activities suitable for them (among which nursing stood out). This was the beginning of the dialectical process within which nursery lies immersed. The objective of denying its former identity by causing the death or deconstruction of the statute of slave and the meaning of coercive words loaded with negative values from the generic point of view that recalcitrantly continue acting as a linguistic and ideological yoke, will only be achieved through critical thought and creative action. This combination can contribute to the emergence of new horizons of freedom and prospects of social, educative, political and professional integration of that double identity so closely linked by history: woman and nurse. Undoubtedly, the evolution of coexistence of a vocational surgery linked to genre with professional and scientific nursery has been, at the same time and paradoxically, a source of conflict and enrichment; but perhaps it is time to establish definitively the limits between one thing and the other. However, as long as all this keeps on happening, we have to recognize that the most delicate part of this process of dialectic struggle is represented by the internal struggle, the civil war of women against women and nurses against nurses that find it impossible to reach a joint decision on essential and basic aspects in order to get a synthesis of what nursery and the role of woman in society would be. In other words, nursing will keep on waiting for the moment in which women may reach their full development in society, always having into account the huge extent of interconnected factors and the complexity of the subject we are dealing with.

References

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     Derrida, J (1998). De la gramatología. Siglo XXI, México.
     Foucault, M (1981). Un diálogo sobre el poder y otras conversaciones, Madrid, Alianza.
     Fukuyama, F (1992). The End of History and the Last Man. Penguin, Harmondsworth.
     Heidegger, M (2000). El ser y el tiempo. Fondo de Cultura Económica, Madrid.
     Kalisch P, et al (1981). When nurses were national heroines: images of nursing in american film 1942-1945. Nurs For; 20(1): 15-61.
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     Kojeve, A (1994). La idea de la muerte en Hegel. Leviatán, Buenos Aires.
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     Lebel JP (1973). Cine e ideología. Ed. Granica, Buenos Aires.
     Linage, A (1999). En torno a las enfermeras de la Guerra Civil. Híades. IV(5-6):169-187.
     Siles, J (1996). Enfermería y conflictos bélicos: una historia por hacer. Index Enferm. V(15):7-8.
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     Stevens SY (1994). Aviation pioneers: World War II air evacuation nurses. Image J Nurs Sch; 26(2): 95-99.

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